This blog post was co-authored by Eric Johnson and Laura Adamski.
When asked about goals for their child, most families who are new to autism services will say things like they want their child to talk, or to use the bathroom independently or to be able to get along better with friends. These are great goals, indeed, but in order to achieve them a fundamental, foundational skill needs to be first put into place. This skill is instructional acceptance.
If one were to think of the building of a house as an analogy for skill-building with children with autism, the importance of each step of the skill=building process could be compared to a section of this house. The foundation of the house would be composed of the ability to accept and respond to instructions. Once a child is able to respond to instructions, other skills such as imitation, language development and social skills can be taught. These secondary skills can be thought of as walls, roof and windows of the house.
What is meant by instructional acceptance, and how does one know when the foundation has been established?
Essentially, instructional acceptance is a child’s willingness to complete a requested instruction without engaging in negative behaviors. An instruction can be as simple as putting a single puzzle piece into a puzzle, or perhaps as complex as attending a birthday party with friends and engaging in appropriate social play. Negative behaviors can vary from eye rolls and slight verbal protests to high levels of aggression and property damage.
Occasional instructional refusal is to be expected with children on the autism spectrum and with neurotypical children as well. When that instructional refusal becomes regular yet unpredictable, what is often described as a “walking on eggshells” feeling, the therapy team might consider a stronger instructional-based approach.
What does an instructional acceptance approach look like?
An instructional acceptance approach can essentially be broken down and defined this way: decreasing demands and increasing reinforcement until a certain level of instructional acceptance has been gained, then slowly working to increase demands and lower reinforcement until the team has found the “sweet spot”—the point at which the child will engage in the highest amount of demands for the lowest amount of reinforcement without engaging in problem behaviors.
One effective way to work to increase instructional acceptance is by targeting skills that are easy for the child, thus reducing the likelihood that low tolerance to frustration is playing a role in a child’s low instructional acceptance. For example, if a child demonstrates a strong proficiency for 12-piece interlocking puzzles, for the sake of establishing or re-establishing instructional acceptance the team may target a 6-piece island puzzle. Knowing that the task is well within the skill level of the client allows the team to turn their focus on other factors that may be contributing to instructional refusal for the task.
Keep in mind that instructional acceptance is often targeted throughout a child’s therapy services. For some children the establishment of instructional acceptance happens rather quickly. For others, instructional acceptance goals are always at the forefront of their programming.
The house visual below demonstrates what the progression toward the teaching of Humor/Sarcasm might look like with a client. Instructional acceptance is the foundation, and a number of prerequisite skills are taught before targeting Humor/Sarcasm with the client. It’s worth noting that the progression of a program like this could vary from months to years, depending on the client.
